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San Joaquin � iley Unified Air Pollution C,,,itrol District <br /> Supplemental Application Form <br /> GASOLINE DISPENSING <br /> This form must be accompanied by a completed Application for Authority to Construct and Permit to Operate form. <br /> Permit to be issued to: <br /> ARCO#6100 <br /> ii Location where the equipment will be operated: i <br /> 25775 S. Patterson Pass Rd.,Tracy, CA <br /> I! a! <br /> Current Permit to Operate number(if applicable): <br /> Instructions <br /> ii 1 Complete a separate form for each tank and dispensing system which has a different type of Phase I or <br /> j; ; Phase II vapor recovery system with as much information as possible. <br /> l� 2 Attach a copy of the site plan showing underground fuel and vapor lines and location of dispenser islands. You <br /> ,± may submit the drawings in electronic format. <br /> Note: Information on Vapor Recovery Executive Orders is available online at: www.arb.ca.gov/vapor/vapor.htm <br /> Gasoline Storage Tanks and Nozzles <br /> Quantity of Type of Tanks Capacity in Gallons Type and Grade <br /> Tanks (Check One for Each Tank) (indicate if Split Tank) of Fuel <br /> 4 ✓ Underground ❑ Aboveground* unknown Unleaded gas <br /> !! ❑ Underground El Aboveground* <br /> !! <br /> n n <br /> !j i i II <br /> n i ❑ Underground ❑ Aboveground* <br /> ❑ Underground ❑ Aboveground* <br /> !! Total Number of Gasoline Dispensers: 4 !' <br /> Total Number of Gasoline Fueling Points: ' $ (Maximum number of vehicles which can be fueled at one time, <br /> g normally two vehicles per dispenser) <br /> Total Number of Gasoline Dispensing Nozzles: 8 (Do not include Diesel) <br /> #Grades of Gasoline Dispensed per Nozzle: 3 <br /> Total Number of Vapor Recovery Instruction Signs: 8 (Should be clearly readable from every fueling point) n <br /> .i <br /> Maximum Facility Gasoline Throughput No change Gallons per Month No change Gallons per year 11 <br /> Facility Type ✓ Retail ❑ Non-Retail <br /> *For Aboveground Tanks (includes tanks in underground vaults) <br /> Manufacturer: <br /> CARB Executive Order Number: <br /> D! cn cf7(,nn!T!a!!fP nnl !.9:liDAcc c!nF7 1) <br />